BEYOND TRAFFICKING ENTRY INFORMATION
Thank you for considering Beyond Trafficking as your place of faith-based restoration and healing.
The intake form below is intended to provide Beyond Trafficking with some basic information. Please fill out the entire form and add a phone number or email that can be reached after 5 p.m. (CST). Please feel free to ask any questions you may have during your intake call.
Once submitted, please allow 24 hours for contact to be made in order to complete the verbal portion.
If Saturday or Sunday (any time) is better for you, please specify. This call typically takes 15-30 minutes.
Association with Survivor*
Survivor's Name (If Different Than Above)
Are you currently in a program?
Are you currently struggling with Substance Abuse?
Have you ever been to a Substance Abuse Program?
Have you been diagnosed with any mental illnesses?